The Adolescent to Adult Patient-centered HIV Transition Study (ADAPT)

以患者为中心的青少年到成人艾滋病毒过渡研究 (ADAPT)

基本信息

批准号：
9206304
负责人：
Manhattan E Charurat
金额：
$ 28.17万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-19 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9206304
关键词：
19 year old Address Adolescence Adolescent Adult Advocate Affect Africa South of the Sahara African Appointment Area Caring Characteristics Child Childhood Clinic Clinical Cluster randomized trial Continuity of Patient Care Country Data Development Education Educational Intervention Ego Enrollment Ensure Epidemiology Equation Evaluation Faculty Focus Groups Funding Government HIV HIV Infections HIV-infected adolescents Health Health Personnel Health care facility Healthcare Systems Human Individual Infection Institutes Institution Intervention Lead Letters Life Maryland Measures Medical Modeling Nigeria Nigerian Outcome Outcome Measure Ownership Parents Participant Pathway interactions Patient-Focused Outcomes Patients Process Provider Psychosocial Factor Randomized Randomized Clinical Trials Research Resources Role Services Site Social Network Social Sciences Social support Structure Support Groups Support System System Time Universities Viral Load result Work adolescent patient aged arm base design effective intervention emerging adult expectation experience follow-up improved innovation insight low and middle-income countries medical schools medical specialties patient oriented pediatric human immunodeficiency virus peer primary outcome programs psychosocial public health relevance randomized trial response satisfaction secondary outcome tool virology

项目摘要

One of the distinct challenges faced by emerging adults with HIV is the transition of their care from their long- term pediatric HIV provider to treatment within an adult HIV program. While conceptually the transition from pediatric to adult care may seem straightforward, the reality is that the transition often is a very difficult process. The consequences of an unsuccessful transition can range from difficult to catastrophic. The Adolescent to Adult Patient-centered HIV Transition (ADAPT) Study is a randomized trial of innovative interventions targeting gaps in care that are major drivers of loss in the ART continuum of care cascade among adolescents and increasing missed opportunities to engage adolescents into care. The specific aims of ADAPT are: (a) to inform strategies for transition services in resource-limited settings; (b) to examine the developmental, clinical, and other factors that predict a successful transition; and (c) to gain fundamental insight on implementation barriers among African adolescents through the application of the ego-network defined social support that will inform targets for structured intervention. Our multi-PI team includes strong complementary expertise in pediatric and adolescent HIV care, epidemiology, and social science. ADAPT will be conducted in central, southern, and northern Nigeria at selected PEPFAR sites supported by the Institute of Human Virology, Nigeria. To address Aim 1 we will conduct six focus groups including: Adolescent patients, parents and health care providers. To address aim 2, we will conduct a cluster randomized clinical trial. The two interventions are based on prior evidence-informed engagement strategies: 1) educational interventions and 2) interventions that use a peer transition advocate who prepares the adolescent and their parents for transition. We will enroll 300 patients (150 patients in each arm). The sites will be randomized to an intervention. The primary outcome will be successful transition, keeping two follow-up appointments within a nine months period following transition. Secondary outcomes, as recommended by focus group participants will also be measured. To examine the potential role of social network components and characteristics of both egos and alters on primary outcomes, a Generalized Estimating Equation (GEE) approach will be used to explore the associations between primary outcomes and factors at the ego, alter, and network levels. The finding from this study will guide institution of best practices for transitioning adolescents in Nigeria and other countries lower and middle income countries with similar challenges and potential for high impact.

患有艾滋病毒的成年人面临的独特挑战之一是他们的护理从长期以来的过渡在成人艾滋病毒计划中接受治疗的儿科艾滋病毒提供者。从概念上讲成人护理的儿科似乎很简单，现实是过渡通常是一个非常困难的过程。不成功的过渡的后果可能从难以到灾难性。这青少年对以患者为中心的HIV转型（Adapt）研究是创新的随机试验针对护理缺口的干预措施是艺术级联级联损失的主要驱动因素青少年和越来越多的机会让青少年参与照顾。具体目的适应为：（a）在资源有限的设置中为过渡服务的策略提供信息；（b）检查预测成功过渡的发展，临床和其他因素；（c）获得基本通过应用自我网络对非洲青少年实施障碍的洞察力定义的社会支持将为目标提供结构化干预的目标。我们的多PI团队包括强大小儿和青少年艾滋病毒护理，流行病学和社会科学方面的互补专业知识。适应威尔在尼日利亚中部，南部和北部在选定的PEPFAR地点进行。人类病毒学，尼日利亚。为了解决目标1，我们将进行六个焦点小组，包括：青春期患者，父母和医疗保健提供者。为了解决AIM 2，我们将进行一项群集随机临床试验。这两种干预措施基于先前的证据信息参与策略：1）教育干预措施 2）使用同伴过渡倡导者的干预措施，他们为青少年及其父母做准备过渡。我们将注册300名患者（每只手臂中有150名患者）。这些站点将被随机分为干涉。主要结果将是成功的过渡，将两次后续约会置于过渡后的九个月。次要结果，焦点小组参与者的建议也将测量。检查社交网络组成部分的潜在作用和两者的特征自我和改变主要结果，一种广义估计方程（GEE）方法将用于探索自我，变更和网络级别的主要结果与因素之间的关联。这从这项研究中找到将指导尼日利亚和其他过渡青少年过渡的最佳实践机构国家低收入和中等收入国家面临类似挑战和高影响力的潜力。